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12.08.30 Paediatric surgery

Hydrocele
  • Distinguishing from hernias
    • Can pinch off and feel cord structures above
    • Transilluminate more than hernias
  • Types
    • With patent processus vaginalis
      • Increasing volumes of fluid can get trapped
      • Potential for hernia formation too
    • Without PPV
      • Usually resolve without intervention within 18 months
  • Consequences
    • None really 
      • cf Varicocele (raised temp causes infertility)
    • Watchful waiting generally fine
  • Frequency
    • 30 % at birth


Inguinal hernias

  • Distinguishing
    • Can't get above it
    • Easier to reduce
  • Frequency
    • 4% at birth
  • Risk of incarceration
    • 50% at 6 months
    • 7% at 1 year


Pyloric stenosis
  • Develops over the first month of life
  • Tends to present at 5-6 weeks
  • Treat by making an incision in the mucosa, allowing the muscular tissue of the sphincter to expand outwards


Undescended testes

  • Frequency
    • 3% at birth
  • Outcome
    • 65% fix themselves within 6 months
    • Wait 6 months, then operate
  • Risks
    • 90% also have PPV
      • => May present with hernia
    • 1% risk of testicular cancer if not fixed by puberty
  • NB testes can re-ascend during rapid pubertal growth


Testicular torsion

  • Occurrence
    • Neonates
    • Adolescents
  • Presentation
    • Excruciating pain over whole testicle
    • Ascending pain
      • Inguinal / iliac fossa
      • Careful to distinguish from appendicitis!


Umbilical hernia

  • 30% of neonates
  • Almost never obstruct
  • => Watchful waiting


Idiopathic scrotal oedema

  • Usually bilateral
    • cf torsion, (epididymo)-orchitis
  • Raw red skin over and around testicle
  • But testes are not tender underneath
  • Resolves in 2-3 days without intervention


Balanitis

  • Inflammation of the glans of the penis
  • Distinguish from just the tip
    • Washing
    • Irritation
  • cf Balanitis xerotica obliterans


Duodenal atresia

  • "Double-bubble" sign on X-ray
    • Stomach + proximal duodenum
  • Bile-stained vomit
  • Extremely serious
    • Transfer immediately to tertiary pediatric surgery centre

Lower intestinal obstruction
  • Hirschsprung's disease
    • Caused by the failure of the neural crest cells to migrate completely
    • Intestine doesn't relax => Blockage
  • Meconium ileus
    • In cystic fibrosis

Vitello-intestinal Duct Remnants
  • Vitello-intestinal duct or omphalo-mesenteric duct connects the midgut to the yolk sac during early embryonic life
  • It gets obliterated and disappears during fifth to sixth week of intrauterine life.If the remnants persists then following abnormalities can occur:
    • Umbilical Polyp
    • Umbilical Sinus
    • Fibrous remnant of vitello-intestinal duct
    • Meckel's Diverticulum
    • Patent Vitello-intestinal duct

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